Download - anadian Paediatric Nursing Standards
Revised June 2017
Canadian Paediatric Nursing Standards
“Standardizing High Quality Nursing Care for Canada’s Children” Recognizing the unique dimensions and growing complexity of health care needs of Canadian children and their families, a group of nursing leaders and clinicians from across Canada came together to develop Canadian-specific paediatric nursing standards. The standards aim to serve as a framework for paediatric nursing delivery across all sectors and provide consistency in describing expertise and scope of practice of a paediatric nurse. From acute to community care and from indigenous to immigrant health, these standards will ultimately guide and ensure consistent and high quality nursing care for all Canada’s children.
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Background 1
What is Paediatric Nursing? 1
Why Canadian Specific Standards? 2
Current Status of Canadian Children 2
Standard Development Process 3
Consultation with Stakeholders &
Literature Review 4
Phased Delphi Process 4
A Vision for the Future 5
The Canadian Standards 5
STANDARD I 6
STANDARD II 7
STANDARD III 8
STANDARD IV 9
STANDARD V 10
Glossary 12
References 14
“There will always be some interest
more immediate than protecting
the well-being of children. There
will never be one more important.”
- UNICEF REPORT CARD 2013
CONTENTS
Technology at work for you BACKGROUND
Practice standards inform scope and expectations of professional nursing. Unlike
many high resource countries, such as the United States and Australia, Canada
does not have national standards for paediatric nursing. Groups such as the
Canadian Association of Paediatric Nurses (CAPN) have attempted to create
national standards; however none have been adopted to date. Recognizing the
unique dimensions and growing complexity of health care needs of Canadian
children* and their families, a group of nursing leaders and clinicians from across
Canada came together to develop Canadian-specific paediatric nursing standards
(standards).
The development of Canadian Paediatric Nursing Standards is anticipated to have
a strong positive impact on nursing practice with children and their families across
all health sectors. Nurses are a valuable resource within the Canadian health care
system and are well-positioned to further influence and advance the protection
and promotion of the well-being of children. From acute to community care and
from indigenous to immigrant health, these standards will ultimately guide and
ensure consistent and high quality nursing care for all Canadian children.
What is Paediatric Nursing?
Paediatric nursing is applying a strengths-based approach to the protection, pro-
motion, and optimization of health and abilities for children from newborn to
young adulthood. Utilizing a child and family-centred care approach, paediatric
nurses require knowledge of psychomotor, psychosocial, and cognitive growth and
development, as well as of the health problems and needs specific to people in
this age group. Preventive care and anticipatory guidance are integral to the prac-
tice of pediatric nursing. Nurses with a specific knowledge base and skillset in
paediatric nursing care can make a difference through leadership and advocacy in
the individual care of the child and the overall state of children’s health in Canada.
Guiding Principles/Assumptions
In the development of paediatric specific nursing standards, it is recognized that
each province and territory has its own regulatory body for nursing. The regula-
tory body sets practice standards and guidelines that apply broadly to all nurses
which outline the expectations for nurses that contribute to public protection.
They inform nurses of their accountabilities and the public of what to expect of
nurses. Core standards apply to all nurses regardless of the role, job description
or area of practice. The Paediatric Nursing Standards are meant to build on this
foundation and to guide the practice of any nurse who has children as either
their entire practice or part of their practice.
* the terms “children” or “child” used throughout this document are meant to be inclusive
of infants, children and youth.
Why Canadian Specific Standards?
Canada has a unique health care system that
spans a vast geography. Ensuring consistency
high quality of care with common standards
across regions and sectors of the health system
will benefit our young and vulnerable Canadian
citizens. Due to differences and uniqueness of
the Canadian health care system, standards and
certification from other countries such as the
United States may not be universally relevant to
paediatric nursing in Canada. It is important to
develop Canada’s own national paediatric
standards that are tailored to its context.
Standards serve as a framework for paediatric
nursing care delivery across all sectors to
support the care needs of Canadian children,
youth and families. Canadian standards of
paediatric nursing determine competencies
across specialties and care environments. The
standards will provide consistency in describing
the expertise and scope of practice of a
paediatric nurse and identify resources that are
easily accessible by paediatric nurses in Canada.
Standards provide role clarity and career
trajectory for paediatric nurses in Canada. The
national standards and potential certification
process will strengthen the paediatric nursing
profession in Canada resulting in role clarity,
credibility and accountability of paediatric
nurses. This would encourage paediatric nurses
to engage in the paediatric nursing profession
and potentially facilitate an increased overall
job satisfaction.
CURRENT HEALTH STATUS OF CANADIAN CHILDREN
In order to develop a set of paediatric nursing standards that is specific to the context of the
Canadian healthcare system, the current health status of Canadian children and health
trends in the care of children and their family were closely examined.
Children and youth make up a considerable proportion of the Canadian population. Out of
approximately 36 million Canadians, 5.8 million are children 14 years and under (16%).
Regions with higher than the national percentage of children in their population
include Nunavut (31.1%); North West Territories (21.4%) and Alberta, Saskachewan
and Manitoba (18.4%, 19.0%, 18.6% respectively) (Statistics Canada, July 2015).
Children are the future of our county but according to the 2013 UNICEF report on Child Well
Being; Canada ranked in a middle position at 17 out of 29 as the average of five dimensions
of child well-being; a ranking that has not advanced in over a decade. More specifically, we
are below average on relative child poverty, infant mortality, immunization, and participation
in further education, NEET (not in education, employment or training), overweight, cannabis
use, bullying, national homicides and children’s life satisfaction. In the dimension of Health &
Safety, Canada ranked only 27 out of 29 developed countries.
In the most recent UNICEF report (2016) children’s well-being is measured by the gap
between those children in middle income families with children at the lowest income level.
Canada has a significantly wider gap in overall well-being between our children than many
other rich countries. Of particular concern is the gap in health symptoms and income
inequality. Canada is one of the countries with both the highest proportion of children
reporting very low life satisfaction (9%) and the widest gap in life satisfaction (28%) between
middle income and the poor.
Even though we have a relatively high proportion of resources, they are still not reaching our
most vulnerable children including First Nations, Metis, Inuit and urban indigenous children
and youth; young people living in poverty; those living in rural and remote communities;
newcomer children and youth; those with mental health concerns and special needs; and
children with obesity concerns.
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CURRENT HEALTH STATUS OF CANADIAN CHILDREN-continued
Indigenous Children & Youth Indigenous children and youth in Canada have significant
challenges in relation to social determinants of health. The level of poverty in indigenous
communities is more than double the general Canadian population at 1 in 4. Infant mortality
is 7 times higher than the general population and there are lower immunization rates
impacting health. These children are 50 times more likely to be hospitalized with preventable
illness. Overall youth are at higher risk for suicide, depression, substance abuse and fetal
alcohol syndrome. Lack of access to health services due to geographical issues makes
indigenous children and youth a more vulnerable population.
Childhood Poverty Canada ranks poorly in the area of relative child poverty (21/29) which
means that there are a high proportion of children who are to some significant extent exclud-
ed from the advantages and opportunities which most children in our society would consider
normal. Approximately one in seven children lives in poor households. Poverty as a major
social determinant of health has been associated with poorer nutrition, decreased maternal
health and is linked to limited educational attainment.
New Immigrant Health Many of the large urban cities in Canada are home to a growing
number of immigrant families with many unique barriers to accessing health care for them-
selves and their children, including language and culture. There is a higher incidence of
poverty in new immigrant households and they are less likely to visit a healthcare profession-
al regularly. It has been shown that health of new immigrants often declines after they arrive
in Canada linked to social determinants of health.
Mental Health About 1.2 million Canadian children are affected by mental health issues
with only 1 in 4 being able to access appropriate treatment. Almost all mental health
problems begin in childhood before the age of 24 years. There is also a growing prevalence of
autism that currently affects 1 in 68 children.
Child Disability, Complex & Chronic Care Disability rates have increased for all child age
categories. When parents have a child with a disability combined with other sources of
stress, it may add strain on the family. The severity of the child’s disability has been shown to
have an impact on whether a parent cited their child’s health as their main source of stress in
daily life. Chronic health conditions in children continue to be a growing concern affecting
15-17 % of all youth.
Childhood Obesity Childhood obesity in Canada is of significant concern. Obesity in
children can lead to chronic conditions such as type II diabetes, hypertension, poor emotion-
al health and diminished social well-being. A startling thirty-two percent of children and
youth ages 5 to 17 years were reported as overweight or obese from 2009 to 2011.
Other groups at risk, but with less information on impact are LGBTTQ young people;
racialized children and youth; those in or leaving the care of Children’s Aid Societies; and
youth in conflict with the law.
In conclusion, we know the early years in a child’s development lays the foundation for
health status as an adult. It is in our best interest to support children’s health to enable the
best start in life to maximize their potential. There is certainly a role for the paediatric nurse
to positively impact that potential.
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Process for Development of Standards
A literature review was conducted as the first phase of the development process of the standards. This allowed for a scan of existing Nursing Standards from oth-er countries and a review of the evidence in paediatric care, paediatric nursing and healthcare for children in general.
In order to assess the need for Canadian specific standards a Think Tank was organized that included a group of paediatric nursing experts in October 2014. There was validation of the literature review and consensus to develop our own National Paediatric Nursing Standards to support the needs of Canadian children and to recognize paediatric nursing as a specialty.
On September 2015, a one and a half day Consensus Summit was held in Toronto bringing together paediatric nursing clinicians and leaders from across the country and from various sectors of healthcare and academics. Using an outcome-focused approach the Summit group worked to develop the first draft of the standards which would be further vetted through an e-Delphi process.
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STANDARDS DEVELOPMENT PROCESS
A. Consultation with Stakeholders and Literature Review
The Standards document was vetted through a Delphi Process to systemati-cally combine expert opinion and arrive at an informed group consensus. The Consensus Summit working group generated a broad list of Delphi partici-pants to ensure representatives from all provinces and territories and across sectors. Limits for consensus were set by the research team prior to the first phase to ensure consistency. A limit of 80% agreement was set for the 5 standard domains, 70% agreement for the Always Events® and 70% agreement for the competencies. The Delphi included questions about the initial draft standards. This feedback was synthesized to informed the next round. At the end of round two there was over 97% agreement with standard domains and over 95% agreement for the Always Events® and the competencies.
B. Phased e-Delphi Process
An Outcomes-Focused Strengths-Based Approach
The standards evolved out of a facilitated consensus summit of paediatric nursing experts from across the country and sectors. Delegates were guided through different phases of a reflective journey using a strength-based approach to examine the current role of paediatric nurses in the care of the child and family. Responses from the delegates were themed and used to inform the framework of the standards.
An outcome-focused approach to development of the standards was used to inform both practice competencies and evaluative practice indicators referred to as Always Events® that align with uniquely paediatric outcomes.
A VISION FOR THE FUTURE
Paediatric Nurses are a powerful
collective force that helps ensure that
all children and families in Canada
have equitable access to high quality
pediatric care regardless of their
circumstances.
Paediatric Nursing Standards are lev-
eraged to prepare the best paediatric
nurses in the world and they are inte-
grated into the practice of any nurse
who works with children, youth and
families in all settings and through key
transitions.
Children, youth and families are
healthier, safer and more able to
reach their full potential as a result of
our leadership in evidence based:
policy development, advocacy, health
promotion, early detection and family
centred care.
The Paediatric Nursing standards are
specific to paediatric nursing practice
and are anchored by Core Standards
which are universally expected of all
nurses, regardless of areas of practice,
specialty or population group. They are
based on the assumption that all nurses
have a foundational scope of practice
and meet regulatory requirements
through their provincial/territorial
regulatory body.
CANADIAN PAEDIATRIC NURSING STANDARDS
The standards are divided into domains that identify five unique aspects of pae-
diatric nursing practice. Under each domain is a description of a specific outcome
that will positively impact the care experience of the child and their family. Each
domain is supported by Always Events® which are behaviours that are so im-
portant to patients and families that health care providers must aim to perform
them consistently and reliably for every patient, every time. Competencies for
the Always Events® can be met in a variety of ways including, but not exclusive
to, formal and informal education, clinical experience, mentorship, reflection,
and self-directed learning. It is anticipated that integration of the Canadian Pae-
diatric Nursing Standards into the practice of all nurses working with children and
their families will allow for the realization of the vision.
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FIVE CORE DOMAINS OF PAEDIATRIC NURSING STANDARDS
Amed’s Story: Out of Control
Asthma
Seven year old Ahmed came to the asthma clinic
as a new patient accompanied by his father,
Khalid. Ahmed had a history of many emergency
room visits for asthma and most recently a PICU
admission. I sat together with them to talk about
Ahmed’s admission to ICU. Ahmed’s father
recalled it happened so fast and how scared he
was that it would happen again. I listened to
Kalhid’s story highlighting positively that he
recognized that Ahmed was having difficulties
breathing and how he quickly called EMS for help.
We talked about the families struggle with two
working parents, three young children and no
medication coverage. Ahmed had not been on
any regular medication before the ICU visit. The
family was currently in subsidized housing that
had mould around the windows and previous
cockroach problems. I worked to understand their
challenges in order to co- create a management
plan that would work for them. Ahmed’s goals
included not missing school or soccer practice
because of asthma. Khalid’s goal was to keep
Ahmed healthy to avoid the emergency visits
which kept him and his wife from their work and
their other children. The health teaching included
what the medicines do, and how to properly
administer medications, what signs to watch for
and what to do when having symptoms. We wrote
everything down in an action plan designed just
for Ahmed. Ahmed was able to demonstrate to
me how he used his spacer and puffers effectively
and he decided he would keep the medicines close
to his toothbrush so he remembered to take it.
We went through strategies to advocate for differ-
ent housing and different options for medication
coverage. In follow up Ahmed had not had any
emergency room visits for asthma and his family
had managed to move to a different unit with the
help of our letters, as well the family enrolled in a
government benefits plan for Ahmed’s on-going
asthma medication needs.
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STANDARD I: Supporting and Partnering with the Child and their Family
Paediatric Nurses partner with the child and their family to achieve their optimal level of health and well-being leading to resilient families and healthy communities.
The Paediatric Nurse always: Establishes an intentional therapeutic relationship with the child and
family Respects the child and family in goal setting and decision making Collects and uses information from the child and family context to
inform care Communicates with both child and family as partners in care Advocates for optimal use of resources to support the child and fami-
ly Recognizes and fosters the parenting role to support child well-being
Areas of Competency: Strengths-Based Nursing Care Child & Family Centred Care Therapeutic communication Family Assessment Child and family advocacy Health teaching for child and family Evidence based knowledge in paediatric care Paediatric end-of-life care
Savie’s Story: Recognizing and
Communicating Danger Signs
Fourteen year old Savie came to the
emergency department complaining of
abdominal pain and fever. She had fainted at
home and was feeling unwell for the past
few days. I noted increased heart rate and
increased temperature, as well the adoles-
cent looked pale and had decreased
perfusion. Blood work was ordered which
showed decreased renal function. Savie
stated she had just finished her period.
While she waited to be assessed by the
casualty officer, she lay quietly playing on
her phone. The physician dismissed the
bloodwork results and other signs based on
the initial look of the child. I reinforced my
concerns related to the bloodwork and vital
signs stating I was concerned Savie may be
in an early stage of shock. Based on the
persistence of the nurse, the physician did a
more complete assessment and did discover
the child was in early shock.
Advocating for your patient is paramount
when they are not able to advocate for
themselves or their parents don’t realize
your concerns for their child’s well-being.
Do your assessment; be sure to pass on all
relevant information as outward
appearances are not always accurate.
STANDARD II: Advocating for Equitable Access and the Rights of Children and their Family
Paediatric Nurses demonstrate and mobilize their understanding of the social determinants and other systemic factors that impact child health.
The Paediatric Nurse always:
Completes a comprehensive assessment (beyond physical assess-ment) through an advocacy lens considering Social Determinants of Health and child well-being
Facilitates an appropriate environment to perform assessment and intervention considering privacy and confidentiality
Builds capacity in the child and their family to self-advocate Engages in a community of practice or network that focuses on
paediatric nursing practice and knowledge and resources for children and families
Supports the child and family to navigate the health care system
Areas of Competency:
Advocacy skills Child and family capacity building Safety and risk assessments Understand the impact of psychosocial and family dynamics on the
health of children Aware of current trends and issues for children, youth and their
families Knowledge of systems and policies that affect child and family
health and well-being Understanding the United Nations’ Conventions on the Rights of
the Child
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Nicholas’ Story: Anticipating
Future Development Needs
Nicolas was a 30 week infant admitted to the NICU for
management of a Tracheal Esophageal Fistula (TEF).
Nicolas’ had to stay in the hospital for 6 months to
grow to be ready for surgery. He requiring continuous
oral suctioning to prevent aspiration. Nicolas was irri-
table and agitated due to the continuous suction , and
oral care. I started to notice that Nicolas was beginning
to develop an oral aversion as he demonstrated no
interest in his soother or self soothing behaviors like
hand to mouth. This was concerning because I knew
that this would become a challenge after surgery when
oral foods would be introduced. Nicolas’ mom also
was concerned and stressed with Nicolas’ level of agi-
tation, and wanted to know what she could do to help.
I discussed with her some of the strategies we used to
keep Nicolas settled as this was important for him to
conserve energy so that he could gain weight and be
ready for surgery sooner. We discussed keeping the
room dimly lit during rest periods, but allowed for
times of day light when Nicolas was awake and interac-
tive. We discussed the importance of the keeping the
noise levels down. I encouraged mom to speak to
Nicolas in a soft voice, as well as reading or singing to
him so he could get to know her voice as a soothing
sound and to help with parental bonding.
Over time as mom became more immersed in com-
pleting Nicolas’ care, I was able to show her some of
Nicolas’ cues of distress and soon she was responding
to his needs independently. To help Nicolas overcome
his oral aversion, we started providing him with
positive oral stimulus. We started with mouthcare
introducing a finger to massage his palate. When it was
safe we completed mouthcare using a small amount of
expressed breast milk (EBM) on a swab so he could get
the taste of his mom’s milk and benefit from the oral
immune therapy. These techniques in combination
with providing routine skin to skin care, Nicolas began
to show interest in suckling at the breast; positive signs
for after his surgery when he could begin oral feeding.
As Nicolas was unable to breastfeed until after his re-
pair, we were able to successfully introduce a soother.
With this he was better able to cope with the environ-
ment and self sooth with his soother or fingers in his
mouth. Although these seem like small feats they
were monumental for Nicolas’ long term development
6 months later when he was finally able to have his
surgery, go home and transition to oral feeds getting
rid of his G tube forever.
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STANDARD III: Delivering Developmentally Appropriate Care
Paediatric Nurses perform assessment based on growth and development and deliver paediatric-specific care.
The Paediatric Nurse always: Demonstrates knowledge of typical development and variation
from typical Demonstrates knowledge of safety risks appropriate for
developmental stage Provides anticipatory guidance and coaching on typical
development and safety related to the developmental stage of the child and family
Performs safety assessments at point of care to minimize risk and harm with developmental stage
Incorporates developmentally appropriate play and/or recreational activities into care
Performs age and developmentally appropriate bio-psychosocial assessment
Uses developmentally appropriate strategies when preparing for and performing interventions
Considers development that is influenced by ethnicity, spirituality and culture
Areas of Competency: Knowledge of common paediatric conditions/illnesses Paediatric Specific Assessment and care delivery Creating a Healing environment Cultural competency Understanding of child development
Danielle’s Story: A Birthday to
Remember
Danielle was a young girl with significant renal failure
for most of her life. She was pre-dialysis when she
developed an additional complication of pancreatitis.
This was severe enough that she was unable to take
any enteral nutrition and for almost a year was NPO,
except for sips of water, and was on TPN. Due to her
illness and the distance she lived from the hospital,
home TPN was not an option. She was lonely and
depressed and in frequent pain. She often refused to
get out of bed or engage in activities with other
children on the ward. She expressed fear that all her
friends were forgetting who she was.
Danielle’s 13th birthday was going to be celebrated
while in hospital, but she was very disappointed that
she could not have her friends and a cake for this
special day. Her nursing team was trying to come up
with a fun activity for her to make the best of a
hospital-based birthday party. We brought in party
favours, and asked her parents to bring in 1-2 of her
best friends on the day. To avoid a “real” cake, which
she would not be able to enjoy and to add humour to
the event, I built a layer cake from wrapped sheets
and towels, decorated it with coloured ribbons and
designed it so that she could “slice” it. We were not
allowed real candles, so battery operated candles
were substituted. Her IV pole was decorated as well,
so that she could ignore or hide the infusions for a
time.
Danielle’s party was a great hit. She laughed at the
silly cake and appreciated that the nurses who do her
physical care every day were willing to take the time
to know what her emotional needs were and to find
ways to meet those needs in a unique way. Danielle’s
parents were appreciative that their daughter could
have some time with friends and families without the
constant interruption of physical care and to be able
to see her laugh for the first in a long time.
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STANDARD IV: Creating a Child & Family Friendly Environ-ment
Paediatric nurses play an essential role in creating a child and family friendly environment that welcomes families and promotes hope and healing. It is understood that the environment changes as the child grows and is influenced by multiple factors including but not exclusive to psychological, spiritual, and social.
The Paediatric Nurse always: Completes a child and family assessment Demonstrates cultural competency and humility in all child and
family interactions Engages with child and family in all care decisions and plan of care
in a respectful non-judgmental, culturally safe manner Shares information relevant to plan of care and collaborates with
and amongst circle of care providers Recognizes and fosters family strengths and supports Uses strategies to support and foster resiliency Demonstrates caring and compassion to both child and family
Areas of Competency: Intra and Interprofessional collaboration (IPC) Cultural competence Strengths based Nursing Child and Family Centred care Resiliency theory Coaching
Annie’s Story: Reunited with
Family
Annie was a 17 year old from Korea who was studying at
a private girl’s school in Canada. Her family had pooled
their financial resources to provide a Canadian education
for their daughter. She had been a top student and very
active in her school and had celebrated her graduation
prom the week before she became ill.
Annie developed sudden onset meningitis-like illness
that remained undiagnosed leaving her completely
unresponsive and in a deep coma. She required a
tracheostomy and ventilator support. She required
enteral feeding and total personal care. She was
unresponsive to touch, sound and only responded to
deep pain. She was able to be weaned off the ventilator
and was transferred from the PICU to an inpatient
medical floor for ongoing supportive and palliative care.
Her parents came to Canada to care for her .
As Annie’s nurse, I provided physical care which was
extensive and difficult as Annie was a tall adolescent,
required extensive and complex care. We posted a photo
of Annie in her prom dress to remind everyone of the
young lady within the unresponsive body. Initially
Annie’s parents were too distraught to participate in
care. However, they were impressed with how we talked
to Annie while providing care as we tried to be efficient
and gentle. With support, they gradually engaged in
more activities; talking with Annie, massaging her limbs,
learning tracheostomy care, setting up and monitoring
gastrostomy tube feeds and more. It was gratifying to
see them begin to become the experts in managing her
care, even though their grasp of English was minimal.
A consistent translator was helpful as well as a nurse on
the unit who spoke Korean and became one of her core
nurses. Over time, as it became apparent that Annie was
not going to recover, the family expressed the strong
desire to take her home to Korea to see her sister and
family . It was a risky undertaking considering how ill she
was and the length of the trip. I engaged the members
of the health care team to arrange this large project. An
external medical transport agency was secured to assist
with the transport to a hospital in Korea. A family friend,
who was also a physician, offered to fly with Annie and
came to learn her care prior to the travel date. After
many weeks of careful planning, all was ready. I had an
emotional “good bye” with the family the evening of
their last day at the hospital. They asked me to pray for
Annie and we all prayed together to ensure a good flight
for her.
Annie and her family arrived safely in Korea and she died
peacefully two months later in a hospital in Korea.
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STANDARD V: Enabling Successful Transitions
Paediatric Nurses support the child and family through health care transitions to maximize their well-being. This may include, but is not limited to, hand-off between healthcare providers, admission and discharge, and facility transfer (such as from paediatric to adult care institutions)
The Paediatric Nurse always: Uses effective communication strategies at all transitions in care Engages in planning of health education and coaching at all
transitions Provides health education and information to optimize transition of
the child and family Assesses readiness and supports safe transition Anticipates resources to support transitions in care Plays an active role in facilitating effective transition
Areas of Competencies: Care coordination Effective Communication Advocacy Assessment of safe environment Discharge planning Child and family centred care Social determinants of health Knowledge of care continuum Knowledge of resources for children and family to facilitate
transition in care Health Coaching
CONCLUSION
The Canadian National Paediatric Nursing Standards are
aimed to have a strong positive impact on ensuring
consistent, high quality paediatric nursing across all
healthcare sectors. From acute to community care and
from indigenous to immigrant health, these standards will
ultimately guide and ensure consistent and high quality
nursing care for all Canada’s children.
The vision is to integrate these standards in daily practice
for nurses in academia, practice and research to positively
impact the health outcomes of our children and their fami-
lies.
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“Closing the gaps between Cana-
da’s children is a team sport—
for governments at all levels,
service organizations, the pri-
vate sector, families and chil-
dren and youth—everyone has
a role. When we work together,
when we put children first, we
all win.”
Unicef.ca/IRC13-2016
GLOSSARY
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Term Definition Advocacy The series of actions taken and issues highlighted to change the “what is” into a “what should be”. It can be under-
taken on behalf of individuals, groups or communities, for example.
Accountability The obligation of an individual or organization to be answerable or responsible for; accepting of blame or liability for actions as a form of governance.
Always Events® Those aspects of the patient experience that are so important to patients and families that health care providers must aim to perform them consistently and reliably for every patient, every time.
Anticipatory Guidance This is a nursing intervention characterised by psychological preparation of a person to help relieve the fear and anxiety of an event or future concerns, expectations that are anticipated to be stressful. Also used to prepare someone for the next stage of a process. An example is the preparation of a child for surgery by explaining what will happen and what it will feel like and showing equipment or the area of the hospital where the child will be. It is also used to prepare parents for the normal growth and development of their child.
Change Agent The person who helps or facilitates in bringing positive change in any area related to health. Nurses also play the role of change agent by bringing improvement in health aspect of people at an individual, family and community level, and in any setting; research, practice and educational. To enact the effective role of change agent the nurse focuses on three main roles; visionary, facilitator, and evaluator.
Child/children A broad term to include those aged newborn to 18 years of age. It is a term intended to include any child, such as neonate, infant, toddler, child, youth, adolescent, etc.
Circle of Care It is a term commonly used to describe the ability of certain health information custodians to assume an individu-al’s implied consent to collect, use or disclose personal health information for the purpose of providing health care, in circumstances defined in provincial Privacy Health Information Acts. https://www.ipc.on.ca/images/Resources/circle-of-care.pdf
Coaching (Health coaching)
Coaching involves a relationship between an experienced individual and a learner for the purpose of supporting the learner through carefully planned advice and guidance to meet specific tasks, objectives and goals. It is different from mentoring, which is usually more general in nature. Health coaching is a specific coaching application where the paediatric nurse partners with the child and family to enhance confidence and competence in the ability of the caregiver/parent and/or the child to self-manage health conditions or make lifestyle changes. Health coaching involves co-creating with the child and family a vision for their health, setting health goals (child’s goals may be different than the family goals) and developing an action plan; asking meaningful questions, actively listening, ob-serving and providing feedback; helping the child and family move forward towards the achievement of the health goals. Adapted from https://www.cna-aiic.ca/~/media/cna/page-content/pdf-en/health-coaching-webinar_e.pdf?la=en
Community of Practice Group of people who share a skill, concern or a passion for something they do and who interact regularly to learn how to do it better. http://wenger-trayner.com/introduction-to-communities-of-practice/
Coping Expending conscious effort to solve personal and interpersonal problems, and seeking to master, minimize or toler-ate stress or conflict. The effectiveness of the coping efforts depends on the type of stress and/or conflict, the particular individual, and the circumstances.
Cultural Competence Is a set of “congruent behaviors, attitudes, and policies that come together in a system, agency, or among profes-sionals that enables the system or professionals to work effectively in cross–cultural situations”. (Cross et al., 1989; Isaacs & Benjamin, 1991). Cultural Competence includes and incorporates the concepts of Cultural Safety and Cul-tural Humility (see next).
Cultural Humility Humility is the quality or state of not thinking you are better or more knowledgeable than others. Cultural humility incorporates a consistent commitment to learning and reflection, but also an understanding of power dynamics and one’s own role in society. It is based on the idea of mutually beneficial relationships rather than one person educating or aiding another in attempt to minimize the power imbalances in client-professional relationships.
Cultural Safety Developed from the idea that to provide quality care for people from different ethnicities and cultures, nurses must provide that care within the cultural values and norms of the patient. The concept of cultural safety challenges the previously accepted standard of transcultural nursing by transferring the power to define the quality of healthcare to patients according to their ethnic, cultural and individual norms. Thus, cultural safety as a concept incorporates the idea of a changed power structure that carries with it potentially difficult social and political ramifications. (National Aboriginal Health Organization (2006a).)
Empowerment Policies and/or measures designed to increase the degree of autonomy and self-determination in lives of people or communities to enable them to represent their own interests or their own authority.
Equitable Being free from favour or prejudice toward any side. It is more than equal in that it considers the unique needs of an individual or group when providing resources as opposed to providing the same resources for all that may not consistently meet individual needs. http://www.unicef.ca/en/unicef-report-card-13-fairness-for-children
This glossary defines the terms used in the context of the Paediatric Nursing Standards.
GLOSSARY—
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Term Definition
Family The word "family" refers to two or more persons who are related in any way—biologically, legally, or emotion-ally. Patients and families define their families. In the patient- and family-centered approach, the definition of family, as well as the degree of the family's involvement in health care is determined by the patient, provided that he or she is developmentally mature and competent to do so. The term "family-centered" is in no way intended to remove control from patients who are competent to make decisions concerning their own health care. In pediatrics, particularly with infants and young children, family members are defined by the patient's parents or guardians. http://www.ipfcc.org/faq.html
Family Assessment A family assessment is a dynamic and ongoing process of gathering, analyzing, comparing, and synthesizing the information from various sources to come to an understanding of family strengths and needs relating to child’s health, safety, permanency and wellbeing. One example of a family assessment model is the Calgary Family Assessment Model (L.M. Wright & M. Leahey (2013). Nurses and Families: A guide to Family Assess-ment and Intervention)
Family Centred Care (also Child and Family Centred Care) Child- and family-centred care is an approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care provid-ers, patients, and families. It redefines the relationships in health care. It recognizes the vital role that families play in ensuring the health and well-being of infants, children, adolescents, and family members of all ages. They acknowledge that emotional, social, and developmental support are integral components of health care. Child and family centered care is an approach to health care that shapes policies, programs, facility design, and staff day-to-day interactions. (adapted from Institute for Patient and Family-Centered Care)
Healing Environment A healing environment describes a physical setting and biopsychosocial culture that supports patients and family through stresses associated with illness, injury, or bereavement. It can include any setting such as hos-pital, clinic, home and any phase of a health care journey.
Interprofessional Col-laboration & Interpro-fessional Education
The World Health Organization defines collaborative practice in health-care as occurring “when multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, carers and communities to deliver the highest quality of care across settings,” and interprofessional education as occurring “when two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes.” (WHO, 2010).
Jordan’s Principle Jordan’s Principle states that the rights of the child should be considered first in providing health care and social services, particularly in instances which involve complex medical needs and diverging interests due to culture or political boundaries. It is particularly relevant for those children within Canada’s aboriginal popula-tion where there can be jurisdictional disputes concerning health care which delay intervention. http://cwrp.ca/jordans-principle
Navigator Providing advice or answering questions to assist in a journey. In health care, a navigator assists with under-standing the health care system, making and planning decisions for services through the sector (locally, pro-vincially or nationally) for individuals, groups, or communities.
Paediatric Nurse Any nurse who works with or for infants, children, and/or youth and their families as part of the nurses clini-cal, education, academic or research focus. Paediatric nurses assess, plan, deliver, and evaluate care in a variety of settings, such as hospitals, homes and in the community, as well as during transfers between these settings either independently with the families or in collaboration with other health care professionals.
Resilience or Resiliency (Theory)
Resilience refers to one’s ability to effectively adapt to stress and adversity, such as illness, injury, family prob-lems, financial issues or interpersonal concerns. Theories of resiliency seek to describe how resiliency can develop or be sustained.
Rights of the Child The Convention on the Rights of the Child was conceived and adopted 25 years ago by the United Nations. The Convention articulated, for the first time, that children also possess innate rights, equal to those of adults: rights to health, to education, to protection and to equal opportunity – without regard to gender, economic status, ethnicity, religious belief, disability or geographical location. And, in conformance with the principles of the Charter of the United Nations and the Universal Declaration of Human Rights, the Convention unequivo-cally recognizes that these rights are “the foundation of freedom, justice and peace in the world.” (UN, 1989). Canada was one of the 196 countries who signed agreement to the convention. http://www.unicef.org/rightsite/files/uncrcchilldfriendlylanguage.pdf
Social Determinants of Health
The primary factors that shape the health of Canadians. There are 14 social determinants of health defined in Canada. They include; income, and income distribution, education, unemployment and job security, employ-ment and working conditions, early childhood development, food insecurity, housing, social exclusion, social safety network, health services, aboriginal status, gender, race, disability.
GLOSSARY,
continued
14
Term Definition
Strengths-Based Care Understanding, uncovering, discovering and releasing biological, intrapersonal, interpersonal, and social strengths to deal with challenges and to meet personal, team and system goals. This new approach does not ignore problems nor pretend that weaknesses and deficits do not exist. Rather, a strengths approach is about working with strengths to deal with problems and deficits. It is about working with people, teams and systems to get the most out of what is important and meaningful to them. It is about restoring the centrality of the nurse-person relationship to promote health and to facilitate healing and in so doing, enhance professional nursing practice. (Gottlieb, 2013).
System An organized, purposeful structure that consists of interrelated and interdependent elements. These elements continually influence one another (directly or indirectly) to maintain their activity and the existence of the system, in order to achieve the goal of the system. If a part of a system is removed or changed, the system will change in some way. Families are considered systems because they are made up of interrelated elements or objectives, they exhibit coherent behaviors, they have regular interactions, and they are interdependent on one another.
Transition Goal of a planned healthcare transition is to maximize wellbeing for children and families and taking into con-sideration their unique needs. Transition can include between care providers or between or within organiza-tions at any stage of the care continuum.
Therapeutic Nurse Client Relationship
The nurse-client relationship is the foundation of nursing practice across all populations and cultures and in all practice settings. Therapeutic nursing services contribute to the client’s health and well-being. The relationship is based on trust, respect, empathy and professional intimacy, and requires appropriate use of the power inherent in the care provider’s role. (College of Nurses of Ontario, 2006)
United Nations’ Con-vention on the Rights of the Child
The United Nations Convention on the Rights of the Child (commonly abbreviated as the CRC, CROC, or UNCRC) is a human rights treaty which sets out the civil, political, economic, social, health and cultural rights of children. The Convention defines a child as any human being under the age of eighteen, unless the age of majority is attained earlier under a state's own domestic legislation.
REFERENCES
College of Nurses of Ontario (2006). Therapeutic Nurse-Client Relationship. Toronto, Ontario retrieved January 25, 2016 from http://www.cno.org/globalassets/docs/prac/41033_therapeutic.pdf
Cross, T., Bazron, B., Dennis, K., & Isaacs, M., (1989). Towards A Culturally Competent System of Care, Vol-ume I. Washington, DC: Georgetown University Child Development Center, CASSP Technical Assistance Center.
Gottlieb, L. (2013). Strengths-Based Nursing Care. Springer Publishing Company, New York, NY.
National Aboriginal Health Organization (2006a). Cultural Safety/ Competence in Aboriginal Health: An Annotated Bibliography. Ottawa: NAHO.
Rollnick S., & Miller, W.R. (1995). What is motivational interviewing? Behavioural and Cognitive Psycho-
therapy, 23, 325-334.
World Health Organization. (2010). Framework for action on interprofessional education and collaborative
practice. Geneva: Author. Retrieved from http://whqlibdoc.who.int/hq/2010/
WHO_HRH_HPN_10.3_eng.pdf
Wright, L.M. & Leahy, M (2013). Calgary Family Assessment Model (CFAM) and Calgary Family Intervention
Model (CFIM), in Nurses and Families: A Guide to Family Assessment and Intervention, 6th Ed., F.A. Davis
Company.
UNICEF. (2014). 25 Years of the Convention on the Rights of the Child. Division of Communication, UNICEF,
New York, NY. Retrieved from http://www.unicef.org/publications/files/
CRC_at_25_Anniversary_Publication_compilation_5Nov2014.pdf
UNICEF. (2016). UNICEF Report Care 13-Fairness for Children: Canada’s Challenge. https://unicef.ca%
2Fen%2Funicef-report-card-13-fairness-for-children&usg=AFQjCNG1Dan-
RUWeFnAgFh_R2f2cyrEtdg&bvm=bv.128617741,d.amc
Eren Alexander—Montreal Children’s Hospital McGill University Health Center, Quebec, Marilyn
Ballantyne—Holland Bloorview Kids Rehabilitation Hospital, Ontario, Catherine Bradbury—Yukon
College, Yukon, Karen Breen-Reid—Canadian Association of Paediatric Nurses / The Hospital for
Sick Children, Ontario, Jennifer Camenzuli—Partners In Community Nursing, Ontario, Kristen
Campbell—Saint Elizabeth Health Care, Ontario, Arlene Chaves—Toronto Central Community
Care Access Centre, Ontario, Amanda Dalgetty—British Columbia Children's Hospital, British Co-
lumbia, Ana DiMambro—Holland Bloorview Kids Rehabilitation Hospital, Ontario, Michele Dur-
rant—The Hospital for Sick Children, Ontario, Rebecca Earle—IWK Health Centre, Nova Scotia, Pa-
tricia Elliott-Miller—Canadian Nurses Association, Ontario, Bonnie Fleming-Carroll—The Hospital
for Sick Children, Ontario, Larissa N Gadsby—Pediatric Nurses Interest Group of the Registered
Nurses Association of Ontario / McMaster Hospital, Ontario, Beverly Gaudet—University of New
Brunswick, New Brunswick, Pam Hubley—Canadian Association of Paediatric Nurses / The Hospi-
tal for Sick Children, Ontario, Kim Krog—Holland Bloorview Kids Rehabilitation Hospital, Ontario,
Gail Macartney—Children’s Hospital of Eastern Ontario, Ontario, Catherine Maser—The Hospital
for Sick Children, Ontario, Mary McAllister—The Hospital for Sick Children, Ontario, Pertice
Moffit—Health Research Programs, Aurora Research Institute, North West Territories, Jennifer
Pearce—Department of Health, Government of Nunavut, Nunavut, Kim Pike—Janeway Children’s
Hospital, Eastern Health, Newfoundland, Adele Riehl—Royal University Hospital Saskatoon
Health Region, Saskatchewan, Daria Romaniuk—Daphne Cockwell School of Nursing, Ryerson
University, Ontario, Louise Rudden—The Hospital for Sick Children, Ontario, Melissa Sallows—
British Columbia Children’s Hospital, British Columbia, Shannon Scarisbrick—Vancouver Island
Health Authority, British Columbia, Jaime Sieuraj—Alberta Health Services – Stollery Children’s
Hospital, Alberta, Julie Smith—Queen Elizabeth Hospital, Prince Edward Island, Fiona So—The
Hospital for Sick Children, Ontario, Karen Spalding—Daphne Cockwell School of Nursing, Ryerson
University, Ontario, Jill Woodward—Alberta Children’s Hospital, Alberta
CANADIAN PAEDIATRIC NURSING STANDARDS ADVISORY GROUP
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